Healthcare Provider Details

I. General information

NPI: 1548164569
Provider Name (Legal Business Name): WOMENS MIDLIFE MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 GODWIN AVE
WYCKOFF NJ
07481-2042
US

IV. Provider business mailing address

258 GODWIN AVE
WYCKOFF NJ
07481-2042
US

V. Phone/Fax

Practice location:
  • Phone: 201-891-3336
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: LINDA PAGNOTTA
Title or Position: OFFICE MANAGER
Credential:
Phone: 201-891-3336